Miniaturization of sebaceous glands: A novel histopathological finding in pemphigus vulgaris and pemphigus foliaceus of the scalp.

BACKGROUND

Intraepidermal acantholysis is a characteristic histopathological feature of pemphigus. The histopathology of scalp biopsies in pemphigus has not been widely discussed in the literature, although the scalp is commonly involved in pemphigus.

METHODS

A total of 32 consecutive patients with scalp involvement (17 with pemphigus vulgaris [PV] and 15 with pemphigus foliaceus [PF]) were enrolled into the study. The histopathological examination of scalp biopsies was performed in all patients. Tissue specimens were stained with hematoxylin and eosin.

RESULTS

Acantholysis extended down the entire length of the outer root sheath of the hair follicle in 12 of 17 (70.6%) patients with PV. Follicular acantholysis in PF was restricted to the infundibulum and occurred in 12 of 15 (80.0%) patients. Acantholysis in the vellus hair follicles was observed in 12 of 17 (70.6%) and 9 of 15 (60.0%) cases, respectively. The miniaturization of sebaceous glands was seen in 14 of 17 (82.4%) and 12 of 15 (80.0%) patients, respectively.

CONCLUSIONS

Follicular acantholysis is a common histopathological feature of pemphigus. It may serve as a clue to the diagnosis of pemphigus subtypes, as PV and PF differ in the depth of follicular acantholysis. The miniaturization of sebaceous glands is a common histopathological feature observed in scalp specimens of patients with pemphigus.